Evidence reviews for involving and supporting parents and carers: Specialist neonatal respiratory care for babies born preterm

Excerpt

Preterm babies receiving respiratory support on a neonatal unit, particularly over a prolonged period, require attention to their ongoing developmental needs. While high-quality medical management and the use of specialised equipment is important for mortality and morbidity, these can also be influenced by the way in which the baby is cared for ex-utero. Attention to positioning, opportunities for contact, particularly skin to skin holding, appropriate progression of feeding and interaction all contribute to optimum neurodevelopmental outcomes. Parents are their baby’s best advocates and carers, a fact that is recognised by the growing implementation of programmes and philosophies of care such as the Newborn Individualised Developmental Care and Assessment Programme (NIDCAP^®) and Family Integrated Care (FIC). Staff training and education in behavioural cues is also necessary in order to support parents and optimise the effectiveness of their involvement in their baby’s care, including maximising opportunities for interaction.

This review aims to explore the effectiveness of parent and carer involvement in the care of preterm babies who are receiving respiratory support and aims to identify which types of involvement can have a positive effect on factors such as length of stay, oxygen dependency and neurodevelopmental outcomes.

For parents, having a premature baby who requires respiratory support is an extremely stressful experience, and can be overwhelming. As well as being an emotionally difficult time, the practical difficulties families might face in being with, and caring for, their baby can cause additional stress and upset. Some families find it difficult to visit their baby consistently, and while many neonatal units offer some practical support to families (like overnight accommodation or help with travel costs), access to support varies between units. Needing respiratory support can also present unique challenges to parent and carers being involved in their baby’s care as well. The baby’s face may be covered making it more difficult to take part in certain aspects of their care because of this, for example feeding, changing or holding their baby.

This review aims to explore the different types of support that parents and carers value when their baby requires respiratory support in neonatal care. It also aims to assess how parents and carers would like to receive support, and to determine ways to improve the parent and carer experience through supporting their presence and involvement in their baby’s care.

Parents and carers of preterm babies who require respiratory support in a neonatal unit see their babies undergoing a range of medical procedures, investigations and treatments. This involves the use of various types of specialist equipment, for example to supply supplemental oxygen or for ventilatory support. They also meet a range of healthcare professionals with varied roles. They may encounter difficulties with caring for their baby, for example associated with the use of face masks, nasal prongs, endotracheal tubes or occasionally a tracheostomy. In general, having a preterm baby receiving respiratory support on a neonatal unit can be a major challenge for parents and carers.

This review will aim to identify information that is valued by parents (for example on equipment, prognosis, treatments, infant health and care, bonding, and parent/carer support), and in what format this information should be provided.